Day in the life of a med student at Matlab

Written by Jessica Sayre, medical student, University of Vermont, 2011

8:30 am: We start the morning with a hearty breakfast at the Matlab Guesthouse. Fresh chapati, omelettes, lentils, vegetables, and sweet rice pudding. Yum! Over breakfast, we chat with two other visitors to the guesthouse: Dr Sharif, a medical officer from the ICDDR,B in Dhaka, and Mary, a charge nurse from the Long Stay Unit in Dhaka.

9:15 am: After tea, we head to the hospital. Matlab is a campus that includes a guest house and meeting center, hospital, prenatal care offices, research offices, a mosque, and other outbuildings, all surrounded by beautiful rice paddies and waterways. We round with Dr Sharif in the Long Stay Unit. Most patients are infants with malnutrition and diarrhoea, and many have complicating conditions such as electrolyte imbalances and pneumonia. During rounds, Dr Sharif points out interesting clinical findings and has us assess the fluid status of a few of the babies. One of the new patients who came in overnight presents with three days of acute watery diarrhoea, fever, moderate dehydration and severe hypernatremia. We calculate the best way to fluid resuscitate her while bringing down her serum sodium slowly. Dr Sharif is worried that she will have convulsions if the sodium level drops too precipitously. We will keep a close eye on her throughout the rest of the day.

10:30 am: After rounds and discussing the patient care plans with the nursing staff and clinical fellow, Dr Sharif sits us down for a teaching session. Today, we talk about fluid management in severely malnourished children presenting with dehydration.

11:30 am: Because of my interest in Pediatrics, I go over to the Kangaroo Maternal Care (KMC) ward where they take care of premature (<37 weeks) and low birth weight (<2 kg) neonates. Instead of using incubators, the ward is kept very warm and the infants are kept between the mothers’ breasts until they are big and healthy enough to be discharged. The KMC Ward has been very successful at reducing infant mortality, and it is certainly different from the NICUs I have seen in the United States!

12:30 pm: Before lunch, we pop our heads into the Obstetric Ward to see if any laboring women are close to delivery. The obstetric physician tells us that there are no impending deliveries, but invites us to check in later.

1:00 pm: Lunch! Today, we have lunch in the hospital canteen where the doctors, nurses, and other hospital staff eat. We then relax outside behind the hospital. We find a sunny bench and enjoy the vibrant colors and peaceful nature of our surroundings. We are far away from the crowded, busy streets of Dhaka!

3:00 pm: After afternoon tea, we head back to the hospital to meet with Dr. Sharif for afternoon rounds. The infant with hypernatremia begins convulsing during our rounds. The nurses quickly give her diazepam and then phenobarbital, and the seizures eventually stop. Dr. Sharif explains to the baby’s mother what is happening and tries to give her some comfort, but the mother is obviously very distressed.

4:00 pm: Mary, the nurse from Dhaka, takes us out on a little tour of the surrounding villages. We visit a home of Parboti, a nurse who works at the Matlab hospital. She is incredibly hospitable and offers us tea, fruits, and sweets. We then go to Chandpur, a larger town where two large rivers come together. We watch the sunset over the water and the fisherman coming in with their catches of the day. We then go to the home of the head nurse and have some snacks before returning back to Matlab.

8:00 pm: We have dinner in the guest house with Mary and Dr Sharif. We discuss religion, marriage, family structures, and cultural differences between Bangladesh and the United States.

9:00 pm: We go with Dr Sharif to check-in on the patients in the hospital. The infant with hypernatremia is doing well and has not had any more convulsions since this afternoon.

10:00 pm: It’s been a long, but very fulfilling day. Goodnight!